Ask YC: What to do with repetitive strain injury problems? | Hacker News Reader

Ask YC: What to do with repetitive strain injury problems?

14 pointsmcfly46 comments

Hi everybody,

I have developed RSI problems (repetitive strain injury) in my lower left arm. At first, it only occurred after playing the guitar. I have since stopped doing that (1 year ago already). But now, my wrist/lower arm hurts even when I am only programming and it's getting a real problem for me. After all, I earn my living as a programmer. I was wondering:

Has anybody else had these problems? What did you do to get better? Was there a "magic trick" that worked for you? Is there a special keyboard you can recommend? Also, do you have experience with some kind of speech recognition software that you can recommend? Is it even possible to use speech recognition with Eclipse, for example?

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I had this really bad about a year ago, and I was really frightened, because it got to the point that not only couldn't I work, I was getting pain just sitting and watching TV! I had it very bad in my wrists, but the worst thing was my elbows - I couldn't bend my arms, and I couldn't not bend my arms. I was really scared.

Anyway, I tried everything, new keyboard, different chairs, vitamins, rubs, Dragon Naturally Speaking, you name it. I even had a kind of pulpit built for my computer so I could work standing up. Since not being able to work would have been a death sentence for me at that time, I spent well over $1000 on this stuff. But none of this really made any difference.

Then, I sat down and thought about how the body works, and all I knew about medicine and biology, and I worked out that the wrist pain was caused by poor muscle condition. So I started exercising my upper body, particularly my arms as someone else pointed out above. That nailed it!

Within a matter of days, all pain went away. I mainly concentrated on standing pushups. Because I'm a woman, I have almost no upper body strength, so I could barely even push myself off the wall on a 25 degree incline. But gradually, doing this very gently every hour or so, I started to increase the incline and get more movement back.

Now, I don't have any pain or problems at all unless I really spend 12 hours in front of the computer. Then, if I get even so much as a twinge, I do the above routine for a day or two and all pain goes away again.

I encountered similar problems and found that Kinesis Advantage Keyboard is a lifesaver. See it at: http://www.kinesis-ergo.com/.

If you are not use to typing on a split keyboard, I would switch to that first, and than to the Kinesis as it can take a few days to get use to. I also use a Logitech Wireless keyboard for gaming purposes, and due to numerous people trying to do a quick google search on my computer and spending half an hour trying to figure out the keyboard.

It's a bit expensive, although you can pick up a slightly used one on ebay for less (that's what I did). However if you think of the amount of time you spend typing and the fact that it is your career $300 is nothing.

I accidentally downmoded you. The Kinesis keyboard is excellent at preventing or alleviating RSI.

I know a bunch of people who swear by these. They helped me, but the Goldtouch helped more.

The way the Kinesis Advantage lays out space, enter, and backspace so they're all under your thumbs should become the standard keyboard layout. It's so much better!

Music physiotherapists, believe it or not, are The People To Talk To. In my case, I had undiagnosed neck issues that were causing me to hunch in a way that screwed up my wrists, and about six sessions fixed it. Gone, never to return (as of 15 years later.)

The body will handle a lot if it is well maintained.

But it needs a specialist, and the people who work with musicians are the top of the field.

Find a good physiotherapist. They'll be able to teach you exercises that you can do yourself to help things.

That is what helped me when I got what sounds like pretty similar to you: Too much guitar playing causing left hand/wrist/arm problems. Unfortunately it still isn't entirely better, but fortunately typing doesn't seem to be a problem with it.

Sort out your posture, wrist/hand position when typing. I'm sure someone else can point you to decent information on this.

I agree completely, a good physio is the way to go. Monitor your results, and if you are not satisfied with the way things are progressing, try another physio. Like anything else, some are better than other.

In terms of the guitar, though, I'd definitely recommend Jamie Andreas's Guitar Principles, to help you play without pain/injury. (It will also improve your playing.)

Yes, see a physical therapist. Don't just try to diagnose yourself, which is what you seem to be doing right now. The pains in my arms and wrists were due entirely to postural problems in my shoulders and neck, which was pinching the nerves leading to my wrists. If I'd kept self-diagnosing I'd have tried keyboard after keyboard, wrist braces, less wrist strain... and have completely missed the small adjustments to my monitor and my chair that actually make the difference.

Plus, PTs can prescribe proper massage, therapy, ultrasound and/or drugs to speed up your healing.

For several years (starting with my senior thesis), I was having a lot of arm and wrist pain when typing. I tried all sorts of things, but what finally made the pain stop was rock climbing. I joined a local climbing gym, and all the pain just went away. If I go for more than a few weeks without climbing my wrists start getting stiff and then hurting again, but as long as I climb regularly the pain stays away. Climbing is also a lot of fun!

Interesting. Can anyone explain why this works? My best guess is: by climbing, you exercise your muscles in that area, thus making them more resistent to damage from typing. But I don't really know anything about medicine.

I suspect it also develops flexibility of the tendons/ligaments.

It isn't even just the muscles in your hands. As I mentioned elsewhere in the thread, my wrist pain is caused by inflamed neck and shoulder muscles. Anything which builds torso strength can improve your posture and solve a lot of second- and third-order problems.

Plus, exercise helps muscles heal and stay healed. They like moving around. Exercise helps keep the blood and lymph flowing through muscles, both directly (I believe that moving around keeps fluids sloshing about and causes blood to be directed to the moving muscles) and indirectly (exercise builds cardiovascular health, which leads to better circulation and oxygenation). It even improves your sleep, which has many excellent side effects.

jwz's writing about his wrist problems is helpful: http://www.jwz.org/gruntle/wrists.html

I have continuing RSI myself, but I've gotten it to the point that it's manageable. Here's what helped me:

- Less stress, more happiness. This was probably the biggest issue for me. Stress made everything worse. Do whatever you need to do to get happy. I quit my job and went on vacation for a month. I also became less willing to do things that made me unhappy.

- Less typing. A lot of people just can't type 12 hours a day, everyday. Come to grips with it, and put yourself on a schedule. Find other things to do. Cut out non-essential typing like IM, etc. Take regular typing breaks. If you can, take some time off and don't even look at a computer for as long as possible.

- More exercise. I'm not sure it even matters if you're exercising the problematic muscles. Just improve your overall health.

- Goldtouch keyboards. These split into an A-shape, so I don't have to pronate my wrists while typing, which was a problem for me. I tried a lot of keyboards, and these are the ones that helped me. Go ahead and spend a bunch of money trying unusual keyboards and desk setups, it's worth it.

- Acupuncture seemed to help a little. I tried pretty much everything anyone suggested. Most other wacky alternative medicine didn't help.

- Tiger Balm. Excellent tingly sensation! Also seems to reduce swelling, which was causing problems for me.

Here's what didn't help me:

- Wrist stretches. I think these may have actually made things worse for me.

- Chiropractic. This made impressive popping noises, and produced no other effects I could discern. Also, it has an adjective for a name.

- Dvorak. The Dvorak layout is designed for speed, not necessarily wrist health. The independent finger movements needed to hit those home-row vowels hurt me bad.

- Doctors. I recommend you see one, but in my case they weren't very helpful. I was diagnosed with CTS, but reading about it, my symptoms didn't remotely match. Wrist braces did nothing. Physical therapy did nothing. Maybe I didn't see very good doctors.

>> Take regular typing breaks. If you can, take some time off and don't even look at a computer for as long as possible.

GNOME has a feature that'll lock the screen every certain number of minutes for a certain number of minutes, and only way to get out of the lock is to ctrl-alt-backspace. Nice if you are having a hard time breaking away from your computer. (System > Prefs > Keyboard > Typing Break)

I used xwrits.

I'll second the holistic approaches mentioned above. For me, almost none of the direct remedies work, but stressing less, relaxing, socializing, enjoying your work, and eating right certainly do.

Also, make sure your sleeping habits aren't hard on your wrists. A lot of people sleep on top of them or keep their wrists curled all night.

I've tried 5 different keyboards, none of which have made much difference. Others have posted some of these but I'll share my list of what has worked:

- take frequent typing breaks -- even 10 to 15 second breaks work wonders.

- stay happy and relaxed, stress is bad. Also, RSI pain can increase stress. Breaks and a chill frame of mind help address this.

- massaging the fingers/wrists under hot tap water first thing in the morning and several times during the day. this feels great and helps focus your mind on relaxing the muscles.

- anti-inflammatory drugs (your doctor may want to prescribe one to help the healing)

- don't pound on the keys. My years using an "M" keyboard got me pounding them pretty hard. I've had to try to unlearn this technique and just use a softer touch.

Suffered horribly, now cured. I won't bother you with the steps that did not work, just the steps that did.

-main thing is to force yourself to use a posture holding your shoulders back and your head / neck back. Laptops are the worst because they force you to look down. As I understand it, the wrist pain is actually neck pain, shoulder pain, arm pain and wrist pain. Your neck, shoulder and arms unconciously make adjustments to relieve pain and the wrist bares the brunt of it because it cannot adjust and pass the pain down the line anymore.

-indoor rock climbing (bouldering) about 20 times helped a ton. I don't go anymore, but the stretching and strength building helped a ton.

-going to yoga about 10 times help also.

-I still don't mouse with my right hand, left only.

The #1 thing for me is to not look down toward the monitor and hold your shoulders and head/neck back. When I read about holding my shoulders back, I did it for 2 days straight and had extremely sore back muscles the next day. The sore muscles got better in a few days and the difference was huge.

Since wrist strain is probably a function of characters typed, it would presumably help to program in more succinct languages.

I mean this quite seriously. I've consciously tried to make Arc easy to type.

I find that a very large fraction of the typing I do while programming is not code entry. An amazing number of keystrokes go to navigating between and within files and directories, running tests, and looking up documentation. A good example of this is debugging -- it's possible to spend hours debugging without entering much code at all.

This also assumes that you'll use your greater productivity per character typed to type less, rather than just maintaining your typing at the same level, and increasing your productivity. Changing your habits is possibly more essential with RSI than changing your tools.

In Lisp dialects you debug mainly by typing expressions.

pg: I disagree -- I still find it puzzling that you made this design decision about Arc. I program mostly in Common Lisp and I use very few keystrokes. SLIME+paredit+redshank in Emacs allow me to do structured code manipulation with impressive dynamic completion (as in m-v-b<TAB> -> multiple-value-bind).

In spite of my RSI problems I don't feel a need for more succinct naming. Succinct languages, yes, abbreviated names, no.

I highly recommend a form of physical therapy called Active Release Techniques (http://www.activerelease.com/). I have had tendinitis in both hands/arms for several years, and regular visits to my ART practitioner have, over a year, improved my situation maybe 50%.

Also I have been using (on and off) the DataHand keyboard, which is wonderful for English text, but unfortunately inconvenient for programming because symbols are a pain to type.

One thing that has always worked for me is increasing your awareness of the muscles and tendons in your hand and arms. Whenever I feel RSI coming up I start typing more slowly and make sure that every movement becomes very soft and gentle.

You'll also learn that when you type more slowly you can still get as much done because your mind has more time to think the problem over while you're typing the code you've already decided you are going to type.

You'll start to notice the little stresses you've learned to ignore and every time you notice a little bit of stress you'll adjust your movement into a more gentle way of interacting with your computer.

As you do this more and more you'll find that your shoulders start relaxing, your neck becomes more relaxed; your breathing slows down and you adjust your computer so that your arms feel featherlight and then your wrists start moving in more fluid movements and your fingers start moving across the keyboard with less resistance until the point at which you might notice that the only stressor left is the tactile pressure of your keyboard and the curvature of your wrists; and then you're ready to try out the keyboard that works best for you and your problems are gone.

When you do this it will become automatic and you'll learn to speed up and slow down back into this mode whenever you feel stress building up again.

The one thing the really exacerbates it for me is stupid notebooks. I find I end up being much more hunched over, and having my wrists in awkward positions vs. a normal keyboard, monitor at a reasonable distance, etc.

Also, I stopped playing guitar for the most part :( because there's just too much overlap in muscles (I guess).

Really, the only answer that works long term though, it just get off the computer. If you're having withdrawl problems (I certainly did) order a whole load of good [computer] books.

If you're looking for something inexpensive to try, you could try installing anti-rsi software like Workrave (Windows/Linux) or AntiRSI (OSX).

They monitor your computer usage and lock you out at regular intervals, so you can have a break, and relax your arms/hands/fingers. Works for me.

http://www.workrave.org/ http://tech.inhelsinki.nl/antirsi/

Thanks for pointing out Workrave! I used to use xwrits when I used Linux, and have been looking for something similar for Windows for a long time.

Here's some tips from someone who went through 2-3 months of not being able to type at all:

1. Get a split keyboard and make sure your wrists are straight when you type. For best results, get a FingerWorks keyboard on ebay and learn to use it. Stop using laptops at all.

2. Type less. Seriously. Turn on dabbrev-mode in Emacs, use SLIME completion when coding Common Lisp. Find a solution. Code the hell out of your editor (Emacs exceeds here). And don't participate in silly online forums.

3. "RSI" doesn't mean anything. Go see a doctor. Your pain could be tendons, muscle, nerves, or joints. It was joints in my case. If you can, see a doctor that specializes in treating sports injuries.

4. Dictation works for E-mail and documentation, but not for coding. If you want to use it, buy Dragon NaturallySpeaking (or MacSpeech dictate, same engine), forget everything else. Then get a microphone that costs at least $100. I use a Sennheiser ME3 from emicrophones. If you can't spend that kind of money, forget dictation.

In my case, cryotherapy, anti-inflammatory medication and typing less helped. If I'm careful, I can now work normally, but I still have to be careful about the amount of typing that I do.

Type slower.

How much of your time in front of the machine do you spend thinking, as opposed to typing? You may find that you can drop your typing speed significantly while having a negligible effect on your overall productivity.

You didn't mention which hand you used to mouse. If you mouse left-handed, try switching hands. I did this - the first few days are hell, but after that you'll be able to mouse effectively enough with the other hand.

Hi. First, sorry to hear about your problem. I too develop a mild pain in my lower left arm every now and then when working long hours, so I can empathize with you.

As far as getting better, I don't believe there is a magic trick. It all boils down to posture and taking appropriate breaks. There have been several discussions on HN about keyboards and desks [http://searchyc.com/keyboard] but it takes a while to find a keyboard that suits you well. I personally have gone through several keyboards and have come to the conclusion that I will have to spend the money to get a really good one.

The other issue, as I mentioned earlier, is taking breaks. Getting up from your desk at regular intervals is good both for your arms, and back as well as your eyes. There are a variety of exercises you can perform while at your desk [http://tinyurl.com/rttqm].

I haven't used any speech recognition software, so I am afraid I can't help you there. In all honesty though, catching this early and doing something about it helps.

Good luck and I wish you well.

mentioned 3 exercises: wrist curls, spinning ball thing and i don't know what the 3rd is called (finger abductors?: expanding your curled fingers outward) in this thread

http://news.ycombinator.com/item?id=185743

http://www.fitter1.com/Catalog/Category/35/HandWrist.aspx

Make sure you don't cock wrists at funny angles when you're driving a car, using power tools, sleeping (don't sleep on your side). And elbow and heel of hand supported weight-wise at all times when working mouse and keyboard.

See http://www.ycombinator.search.xirium.com/cgi-bin/search.cgi?... and http://www.ycombinator.search.xirium.com/cgi-bin/search.cgi?...

Have you tried myotherapy? http://en.wikipedia.org/wiki/Myotherapy Ive had problems more in the shoulder area and upper back. This treatment for just a week brought in so much relief to me. Of course a permanent cure is not possible in a short time and it involves better posture, exercises, breaks etc

I used to suffer from RSI in both my wrists years ago. Switching to ergonomic keyboards solved the problem. I'm using the "Microsoft Natural Ergonomic Keyboard". Just to prove that this was indeed the cause, whenever I travel for a while with my laptop only, my wrists start hurting again.

John Ousterhout and I worked together for years... he talks to his computer. See his description here: http://home.pacbell.net/ouster/wrist.html

I talked to my computer for about six months. It was a much-needed break for my wrists, and a lot more practical than I expected.

I found I had to be very careful not to hurt my voice, though. Talking to a computer puts more strain on your voice than normal conversation.

I used Dragon NaturallySpeaking, by the way. It's a ridiculously bug-ridden pile of crap, but it's basically the only game in town. You can use it for just about everything on Windows, though apps that use native GUI widgets are much easier to work with than those that don't.

1. Never ever contemplate using a conventional desktop keyboard (How anyone types on those things is beyond me). Use a laptop style keyboard with small key travel and easily pressed keys. 2. Use a touchpad instead of a mouse.

Also personally I'm one for using a laptop so you can get pretty comfy in a ton of positions - lying on bed, lounging on a sofa, lying on the floor, sitting at a table (Rarely).

1. take typing brakes (xwrits, workrave) 2. exercise -- specially try to make your shoulders, forearms, and fingers stronger (in that order) 3. stretch -- yoga can help, take a class 4. get in better shape (run, bike, elliptical, ...) 5. don't type more than 4 hours a day (workrave can help here) 6. DON'T GET SURGERY!!!!! quit first, and reassess things.

one of my friends tried yoga and that helped him get rid off all the pain.

ymmv.

I also have the impression that Yoga helped me a lot. I still have some problems, but in general my hands feel much better.

Hi - I have had good luck with these two things - the Evoluent vertical mouse & the Goldtouch split keyboard. Try using the left hand mouse for a day and switch to the right hand mouse to relieve pain.

I had similar problems as well, got myself a better keyboard (Apple) and carry it everywhere. Do not type on your laptop's keyboard!

Also, don't assume that you can code for hours on end, take a break.

Hi. There is no magic cure. I've found that swimming helps because it involves whole body movement. The most important thing you can do is to take restbreaks (I use WorkPace software)

Not sure if anybody reads this since the thread is already off the first page, but still: Thank you all! I think there is some great advice and I am positive that it will help me.

Typing on a Dvorak keyboard layout can help prevent RSI. At least I did not have any problems with it after switching.

for me:

1. Microsoft split keyboard

2. Dvorak

3. Wacom tablet instead of mouse

i would add Vim but i'm not sure it helps with those things. it's certainly more efficient for code editing. anyways, i haven't had so much as an inkling of pain in years

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